|
PR REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS 13153
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$307.45 |
| Rate for Payer: Aetna Commercial |
$175.39
|
| Rate for Payer: Aetna Medicare |
$136.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.48
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS MAPPO |
$130.89
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$271.70
|
| Rate for Payer: BCN Medicare Advantage |
$130.89
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cofinity Commercial |
$175.39
|
| Rate for Payer: Cofinity Commercial |
$188.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.43
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Nomi Health Commercial |
$157.07
|
| Rate for Payer: PACE SWMI |
$130.89
|
| Rate for Payer: PHP Commercial |
$183.25
|
| Rate for Payer: PHP Medicare Advantage |
$130.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.86
|
| Rate for Payer: Priority Health Medicare |
$130.89
|
| Rate for Payer: Priority Health Narrow Network |
$182.86
|
| Rate for Payer: Priority Health SBD |
$182.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.89
|
| Rate for Payer: UHC Medicare Advantage |
$130.89
|
| Rate for Payer: UHCCP Medicaid |
$87.33
|
| Rate for Payer: UMR Bronson Commercial |
$217.58
|
|
|
PR REPAIR CONGENITAL AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$4,223.00
|
|
|
Service Code
|
HCPCS 35184
|
| Min. Negotiated Rate |
$604.49 |
| Max. Negotiated Rate |
$2,744.95 |
| Rate for Payer: Aetna Commercial |
$1,245.81
|
| Rate for Payer: Aetna Medicare |
$966.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,245.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,338.78
|
| Rate for Payer: BCBS Complete |
$634.71
|
| Rate for Payer: BCBS MAPPO |
$929.71
|
| Rate for Payer: BCBS Trust/PPO |
$669.36
|
| Rate for Payer: BCN Commercial |
$1,376.60
|
| Rate for Payer: BCN Medicare Advantage |
$929.71
|
| Rate for Payer: Cash Price |
$3,378.40
|
| Rate for Payer: Cash Price |
$3,378.40
|
| Rate for Payer: Cofinity Commercial |
$1,245.81
|
| Rate for Payer: Cofinity Commercial |
$1,338.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$976.20
|
| Rate for Payer: Meridian Medicaid |
$634.71
|
| Rate for Payer: Nomi Health Commercial |
$1,115.65
|
| Rate for Payer: PACE SWMI |
$929.71
|
| Rate for Payer: PHP Commercial |
$1,301.59
|
| Rate for Payer: PHP Medicare Advantage |
$929.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$604.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,744.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,505.07
|
| Rate for Payer: Priority Health Medicare |
$929.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,505.07
|
| Rate for Payer: Priority Health SBD |
$1,505.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$929.71
|
| Rate for Payer: UHC Medicare Advantage |
$929.71
|
| Rate for Payer: UHCCP Medicaid |
$604.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,942.58
|
|
|
PR REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA
|
Professional
|
Both
|
$1,951.00
|
|
|
Service Code
|
HCPCS 25425
|
| Min. Negotiated Rate |
$517.47 |
| Max. Negotiated Rate |
$1,484.86 |
| Rate for Payer: Aetna Commercial |
$1,245.92
|
| Rate for Payer: Aetna Medicare |
$966.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,245.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,338.90
|
| Rate for Payer: BCBS Complete |
$657.75
|
| Rate for Payer: BCBS MAPPO |
$929.79
|
| Rate for Payer: BCBS Trust/PPO |
$517.47
|
| Rate for Payer: BCN Commercial |
$1,415.70
|
| Rate for Payer: BCN Medicare Advantage |
$929.79
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cofinity Commercial |
$1,245.92
|
| Rate for Payer: Cofinity Commercial |
$1,338.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$976.28
|
| Rate for Payer: Meridian Medicaid |
$657.75
|
| Rate for Payer: Nomi Health Commercial |
$1,115.75
|
| Rate for Payer: PACE SWMI |
$929.79
|
| Rate for Payer: PHP Commercial |
$1,301.71
|
| Rate for Payer: PHP Medicare Advantage |
$929.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$626.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,268.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,484.86
|
| Rate for Payer: Priority Health Medicare |
$929.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,484.86
|
| Rate for Payer: Priority Health SBD |
$1,484.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$929.79
|
| Rate for Payer: UHC Medicare Advantage |
$929.79
|
| Rate for Payer: UHCCP Medicaid |
$626.43
|
| Rate for Payer: UMR Bronson Commercial |
$897.46
|
|
|
PR REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT
|
Professional
|
Both
|
$2,169.00
|
|
|
Service Code
|
HCPCS 27676
|
| Min. Negotiated Rate |
$397.67 |
| Max. Negotiated Rate |
$3,872.44 |
| Rate for Payer: Aetna Commercial |
$787.58
|
| Rate for Payer: Aetna Medicare |
$611.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.36
|
| Rate for Payer: BCBS Complete |
$417.55
|
| Rate for Payer: BCBS MAPPO |
$587.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,872.44
|
| Rate for Payer: BCN Commercial |
$889.88
|
| Rate for Payer: BCN Medicare Advantage |
$587.75
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cofinity Commercial |
$787.58
|
| Rate for Payer: Cofinity Commercial |
$846.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$617.14
|
| Rate for Payer: Meridian Medicaid |
$417.55
|
| Rate for Payer: Nomi Health Commercial |
$705.30
|
| Rate for Payer: PACE SWMI |
$587.75
|
| Rate for Payer: PHP Commercial |
$822.85
|
| Rate for Payer: PHP Medicare Advantage |
$587.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$397.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,409.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$941.39
|
| Rate for Payer: Priority Health Medicare |
$587.75
|
| Rate for Payer: Priority Health Narrow Network |
$941.39
|
| Rate for Payer: Priority Health SBD |
$941.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$587.75
|
| Rate for Payer: UHC Medicare Advantage |
$587.75
|
| Rate for Payer: UHCCP Medicaid |
$397.67
|
| Rate for Payer: UMR Bronson Commercial |
$997.74
|
|
|
PR REPAIR ECTROPION EXTENSIVE
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 67917
|
| Min. Negotiated Rate |
$289.47 |
| Max. Negotiated Rate |
$908.94 |
| Rate for Payer: Aetna Commercial |
$565.17
|
| Rate for Payer: Aetna Medicare |
$438.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$607.35
|
| Rate for Payer: BCBS Complete |
$303.94
|
| Rate for Payer: BCBS MAPPO |
$421.77
|
| Rate for Payer: BCBS Trust/PPO |
$744.37
|
| Rate for Payer: BCN Commercial |
$908.94
|
| Rate for Payer: BCN Medicare Advantage |
$421.77
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cofinity Commercial |
$565.17
|
| Rate for Payer: Cofinity Commercial |
$607.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.86
|
| Rate for Payer: Meridian Medicaid |
$303.94
|
| Rate for Payer: Nomi Health Commercial |
$506.12
|
| Rate for Payer: PACE SWMI |
$421.77
|
| Rate for Payer: PHP Commercial |
$590.48
|
| Rate for Payer: PHP Medicare Advantage |
$421.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$793.13
|
| Rate for Payer: Priority Health Medicare |
$421.77
|
| Rate for Payer: Priority Health Narrow Network |
$793.13
|
| Rate for Payer: Priority Health SBD |
$793.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.77
|
| Rate for Payer: UHC Medicare Advantage |
$421.77
|
| Rate for Payer: UHCCP Medicaid |
$289.47
|
| Rate for Payer: UMR Bronson Commercial |
$575.00
|
|
|
PR REPAIR ENTEROCELE ABDOMINAL APPROACH SPX
|
Professional
|
Both
|
$2,063.00
|
|
|
Service Code
|
HCPCS 57270
|
| Min. Negotiated Rate |
$520.57 |
| Max. Negotiated Rate |
$2,459.24 |
| Rate for Payer: Aetna Commercial |
$1,042.55
|
| Rate for Payer: Aetna Medicare |
$809.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,042.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,120.35
|
| Rate for Payer: BCBS Complete |
$546.60
|
| Rate for Payer: BCBS MAPPO |
$778.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,459.24
|
| Rate for Payer: BCN Commercial |
$1,193.84
|
| Rate for Payer: BCN Medicare Advantage |
$778.02
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cofinity Commercial |
$1,042.55
|
| Rate for Payer: Cofinity Commercial |
$1,120.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$778.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$816.92
|
| Rate for Payer: Meridian Medicaid |
$546.60
|
| Rate for Payer: Nomi Health Commercial |
$933.62
|
| Rate for Payer: PACE SWMI |
$778.02
|
| Rate for Payer: PHP Commercial |
$1,089.23
|
| Rate for Payer: PHP Medicare Advantage |
$778.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$520.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,340.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,216.31
|
| Rate for Payer: Priority Health Medicare |
$778.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,216.31
|
| Rate for Payer: Priority Health SBD |
$1,216.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$778.02
|
| Rate for Payer: UHC Medicare Advantage |
$778.02
|
| Rate for Payer: UHCCP Medicaid |
$520.57
|
| Rate for Payer: UMR Bronson Commercial |
$948.98
|
|
|
PR REPAIR ENTEROCELE VAGINAL APPROACH SPX
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 57268
|
| Min. Negotiated Rate |
$325.89 |
| Max. Negotiated Rate |
$2,026.03 |
| Rate for Payer: Aetna Commercial |
$647.09
|
| Rate for Payer: Aetna Medicare |
$502.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$695.38
|
| Rate for Payer: BCBS Complete |
$342.18
|
| Rate for Payer: BCBS MAPPO |
$482.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,026.03
|
| Rate for Payer: BCN Commercial |
$744.75
|
| Rate for Payer: BCN Medicare Advantage |
$482.90
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$647.09
|
| Rate for Payer: Cofinity Commercial |
$695.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$482.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$507.04
|
| Rate for Payer: Meridian Medicaid |
$342.18
|
| Rate for Payer: Nomi Health Commercial |
$579.48
|
| Rate for Payer: PACE SWMI |
$482.90
|
| Rate for Payer: PHP Commercial |
$676.06
|
| Rate for Payer: PHP Medicare Advantage |
$482.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$760.44
|
| Rate for Payer: Priority Health Medicare |
$482.90
|
| Rate for Payer: Priority Health Narrow Network |
$760.44
|
| Rate for Payer: Priority Health SBD |
$760.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$482.90
|
| Rate for Payer: UHC Medicare Advantage |
$482.90
|
| Rate for Payer: UHCCP Medicaid |
$325.89
|
| Rate for Payer: UMR Bronson Commercial |
$703.80
|
|
|
PR REPAIR ENTROPION SUTURE
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 67921
|
| Min. Negotiated Rate |
$198.94 |
| Max. Negotiated Rate |
$697.83 |
| Rate for Payer: Aetna Commercial |
$385.37
|
| Rate for Payer: Aetna Medicare |
$299.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.13
|
| Rate for Payer: BCBS Complete |
$208.89
|
| Rate for Payer: BCBS MAPPO |
$287.59
|
| Rate for Payer: BCBS Trust/PPO |
$584.83
|
| Rate for Payer: BCN Commercial |
$697.83
|
| Rate for Payer: BCN Medicare Advantage |
$287.59
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cofinity Commercial |
$385.37
|
| Rate for Payer: Cofinity Commercial |
$414.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.97
|
| Rate for Payer: Meridian Medicaid |
$208.89
|
| Rate for Payer: Nomi Health Commercial |
$345.11
|
| Rate for Payer: PACE SWMI |
$287.59
|
| Rate for Payer: PHP Commercial |
$402.63
|
| Rate for Payer: PHP Medicare Advantage |
$287.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$545.71
|
| Rate for Payer: Priority Health Medicare |
$287.59
|
| Rate for Payer: Priority Health Narrow Network |
$545.71
|
| Rate for Payer: Priority Health SBD |
$545.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.59
|
| Rate for Payer: UHC Medicare Advantage |
$287.59
|
| Rate for Payer: UHCCP Medicaid |
$198.94
|
| Rate for Payer: UMR Bronson Commercial |
$310.04
|
|
|
PR REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 26433
|
| Min. Negotiated Rate |
$330.19 |
| Max. Negotiated Rate |
$902.20 |
| Rate for Payer: Aetna Commercial |
$710.45
|
| Rate for Payer: Aetna Medicare |
$551.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.47
|
| Rate for Payer: BCBS Complete |
$386.46
|
| Rate for Payer: BCBS MAPPO |
$530.19
|
| Rate for Payer: BCBS Trust/PPO |
$330.19
|
| Rate for Payer: BCN Commercial |
$854.70
|
| Rate for Payer: BCN Medicare Advantage |
$530.19
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$710.45
|
| Rate for Payer: Cofinity Commercial |
$763.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$556.70
|
| Rate for Payer: Meridian Medicaid |
$386.46
|
| Rate for Payer: Nomi Health Commercial |
$636.23
|
| Rate for Payer: PACE SWMI |
$530.19
|
| Rate for Payer: PHP Commercial |
$742.27
|
| Rate for Payer: PHP Medicare Advantage |
$530.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$885.93
|
| Rate for Payer: Priority Health Medicare |
$530.19
|
| Rate for Payer: Priority Health Narrow Network |
$885.93
|
| Rate for Payer: Priority Health SBD |
$885.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.19
|
| Rate for Payer: UHC Medicare Advantage |
$530.19
|
| Rate for Payer: UHCCP Medicaid |
$368.06
|
| Rate for Payer: UMR Bronson Commercial |
$638.48
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH
|
Professional
|
Both
|
$1,788.00
|
|
|
Service Code
|
HCPCS 26420
|
| Min. Negotiated Rate |
$66.57 |
| Max. Negotiated Rate |
$1,162.20 |
| Rate for Payer: Aetna Commercial |
$925.65
|
| Rate for Payer: Aetna Medicare |
$718.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$925.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$994.72
|
| Rate for Payer: BCBS Complete |
$500.76
|
| Rate for Payer: BCBS MAPPO |
$690.78
|
| Rate for Payer: BCBS Trust/PPO |
$66.57
|
| Rate for Payer: BCN Commercial |
$1,105.38
|
| Rate for Payer: BCN Medicare Advantage |
$690.78
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cofinity Commercial |
$925.65
|
| Rate for Payer: Cofinity Commercial |
$994.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$690.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$725.32
|
| Rate for Payer: Meridian Medicaid |
$500.76
|
| Rate for Payer: Nomi Health Commercial |
$828.94
|
| Rate for Payer: PACE SWMI |
$690.78
|
| Rate for Payer: PHP Commercial |
$967.09
|
| Rate for Payer: PHP Medicare Advantage |
$690.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,149.00
|
| Rate for Payer: Priority Health Medicare |
$690.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,149.00
|
| Rate for Payer: Priority Health SBD |
$1,149.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$690.78
|
| Rate for Payer: UHC Medicare Advantage |
$690.78
|
| Rate for Payer: UHCCP Medicaid |
$476.91
|
| Rate for Payer: UMR Bronson Commercial |
$822.48
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH
|
Professional
|
Both
|
$1,309.00
|
|
|
Service Code
|
HCPCS 26418
|
| Min. Negotiated Rate |
$132.08 |
| Max. Negotiated Rate |
$968.86 |
| Rate for Payer: Aetna Commercial |
$772.68
|
| Rate for Payer: Aetna Medicare |
$599.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.35
|
| Rate for Payer: BCBS Complete |
$422.48
|
| Rate for Payer: BCBS MAPPO |
$576.63
|
| Rate for Payer: BCBS Trust/PPO |
$132.08
|
| Rate for Payer: BCN Commercial |
$930.93
|
| Rate for Payer: BCN Medicare Advantage |
$576.63
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cofinity Commercial |
$772.68
|
| Rate for Payer: Cofinity Commercial |
$830.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$576.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$605.46
|
| Rate for Payer: Meridian Medicaid |
$422.48
|
| Rate for Payer: Nomi Health Commercial |
$691.96
|
| Rate for Payer: PACE SWMI |
$576.63
|
| Rate for Payer: PHP Commercial |
$807.28
|
| Rate for Payer: PHP Medicare Advantage |
$576.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$402.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$968.86
|
| Rate for Payer: Priority Health Medicare |
$576.63
|
| Rate for Payer: Priority Health Narrow Network |
$968.86
|
| Rate for Payer: Priority Health SBD |
$968.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$576.63
|
| Rate for Payer: UHC Medicare Advantage |
$576.63
|
| Rate for Payer: UHCCP Medicaid |
$402.36
|
| Rate for Payer: UMR Bronson Commercial |
$602.14
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/GRAFT EACH
|
Professional
|
Both
|
$1,933.00
|
|
|
Service Code
|
HCPCS 26412
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$1,256.45 |
| Rate for Payer: Aetna Commercial |
$892.28
|
| Rate for Payer: Aetna Medicare |
$692.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$892.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$958.87
|
| Rate for Payer: BCBS Complete |
$483.30
|
| Rate for Payer: BCBS MAPPO |
$665.88
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$1,067.76
|
| Rate for Payer: BCN Medicare Advantage |
$665.88
|
| Rate for Payer: Cash Price |
$1,546.40
|
| Rate for Payer: Cash Price |
$1,546.40
|
| Rate for Payer: Cofinity Commercial |
$892.28
|
| Rate for Payer: Cofinity Commercial |
$958.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$665.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$699.17
|
| Rate for Payer: Meridian Medicaid |
$483.30
|
| Rate for Payer: Nomi Health Commercial |
$799.06
|
| Rate for Payer: PACE SWMI |
$665.88
|
| Rate for Payer: PHP Commercial |
$932.23
|
| Rate for Payer: PHP Medicare Advantage |
$665.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,256.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,107.29
|
| Rate for Payer: Priority Health Medicare |
$665.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,107.29
|
| Rate for Payer: Priority Health SBD |
$1,107.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$665.88
|
| Rate for Payer: UHC Medicare Advantage |
$665.88
|
| Rate for Payer: UHCCP Medicaid |
$460.29
|
| Rate for Payer: UMR Bronson Commercial |
$889.18
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Professional
|
Both
|
$1,257.00
|
|
|
Service Code
|
HCPCS 26410
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$931.72 |
| Rate for Payer: Aetna Commercial |
$745.98
|
| Rate for Payer: Aetna Medicare |
$578.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$745.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$801.65
|
| Rate for Payer: BCBS Complete |
$406.37
|
| Rate for Payer: BCBS MAPPO |
$556.70
|
| Rate for Payer: BCBS Trust/PPO |
$154.79
|
| Rate for Payer: BCN Commercial |
$897.21
|
| Rate for Payer: BCN Medicare Advantage |
$556.70
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cofinity Commercial |
$745.98
|
| Rate for Payer: Cofinity Commercial |
$801.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$556.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$584.54
|
| Rate for Payer: Meridian Medicaid |
$406.37
|
| Rate for Payer: Nomi Health Commercial |
$668.04
|
| Rate for Payer: PACE SWMI |
$556.70
|
| Rate for Payer: PHP Commercial |
$779.38
|
| Rate for Payer: PHP Medicare Advantage |
$556.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$931.72
|
| Rate for Payer: Priority Health Medicare |
$556.70
|
| Rate for Payer: Priority Health Narrow Network |
$931.72
|
| Rate for Payer: Priority Health SBD |
$931.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$556.70
|
| Rate for Payer: UHC Medicare Advantage |
$556.70
|
| Rate for Payer: UHCCP Medicaid |
$387.02
|
| Rate for Payer: UMR Bronson Commercial |
$578.22
|
|
|
PR REPAIR FASCIAL DEFECT LEG
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 27656
|
| Min. Negotiated Rate |
$220.88 |
| Max. Negotiated Rate |
$1,234.11 |
| Rate for Payer: Aetna Commercial |
$434.35
|
| Rate for Payer: Aetna Medicare |
$337.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.76
|
| Rate for Payer: BCBS Complete |
$231.92
|
| Rate for Payer: BCBS MAPPO |
$324.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.11
|
| Rate for Payer: BCN Commercial |
$789.70
|
| Rate for Payer: BCN Medicare Advantage |
$324.14
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Commercial |
$434.35
|
| Rate for Payer: Cofinity Commercial |
$466.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$340.35
|
| Rate for Payer: Meridian Medicaid |
$231.92
|
| Rate for Payer: Nomi Health Commercial |
$388.97
|
| Rate for Payer: PACE SWMI |
$324.14
|
| Rate for Payer: PHP Commercial |
$453.80
|
| Rate for Payer: PHP Medicare Advantage |
$324.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$528.19
|
| Rate for Payer: Priority Health Medicare |
$324.14
|
| Rate for Payer: Priority Health Narrow Network |
$528.19
|
| Rate for Payer: Priority Health SBD |
$528.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.14
|
| Rate for Payer: UHC Medicare Advantage |
$324.14
|
| Rate for Payer: UHCCP Medicaid |
$220.88
|
| Rate for Payer: UMR Bronson Commercial |
$425.50
|
|
|
PR REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION
|
Professional
|
Both
|
$4,033.00
|
|
|
Service Code
|
HCPCS 27726
|
| Min. Negotiated Rate |
$621.32 |
| Max. Negotiated Rate |
$2,621.45 |
| Rate for Payer: Aetna Commercial |
$1,238.27
|
| Rate for Payer: Aetna Medicare |
$961.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,238.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,330.68
|
| Rate for Payer: BCBS Complete |
$652.39
|
| Rate for Payer: BCBS MAPPO |
$924.08
|
| Rate for Payer: BCBS Trust/PPO |
$746.49
|
| Rate for Payer: BCN Commercial |
$1,403.48
|
| Rate for Payer: BCN Medicare Advantage |
$924.08
|
| Rate for Payer: Cash Price |
$3,226.40
|
| Rate for Payer: Cash Price |
$3,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,238.27
|
| Rate for Payer: Cofinity Commercial |
$1,330.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$924.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$970.28
|
| Rate for Payer: Meridian Medicaid |
$652.39
|
| Rate for Payer: Nomi Health Commercial |
$1,108.90
|
| Rate for Payer: PACE SWMI |
$924.08
|
| Rate for Payer: PHP Commercial |
$1,293.71
|
| Rate for Payer: PHP Medicare Advantage |
$924.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$621.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,621.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,468.06
|
| Rate for Payer: Priority Health Medicare |
$924.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,468.06
|
| Rate for Payer: Priority Health SBD |
$1,468.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$924.08
|
| Rate for Payer: UHC Medicare Advantage |
$924.08
|
| Rate for Payer: UHCCP Medicaid |
$621.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,855.18
|
|
|
PR REPAIR FIRST ABDOMINAL WALL HERNIA
|
Professional
|
Both
|
$2,106.00
|
|
|
Service Code
|
HCPCS 49560
|
| Min. Negotiated Rate |
$842.40 |
| Max. Negotiated Rate |
$1,368.90 |
| Rate for Payer: Aetna Medicare |
$1,053.00
|
| Rate for Payer: BCBS Complete |
$842.40
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,368.90
|
| Rate for Payer: UMR Bronson Commercial |
$968.76
|
|
|
PR REPAIR FISTULA OROMAXILLARY
|
Professional
|
Both
|
$1,483.00
|
|
|
Service Code
|
HCPCS 30580
|
| Min. Negotiated Rate |
$299.48 |
| Max. Negotiated Rate |
$963.95 |
| Rate for Payer: Aetna Commercial |
$589.79
|
| Rate for Payer: Aetna Medicare |
$457.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$589.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.80
|
| Rate for Payer: BCBS Complete |
$314.45
|
| Rate for Payer: BCBS MAPPO |
$440.14
|
| Rate for Payer: BCBS Trust/PPO |
$804.60
|
| Rate for Payer: BCN Commercial |
$894.28
|
| Rate for Payer: BCN Medicare Advantage |
$440.14
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cofinity Commercial |
$589.79
|
| Rate for Payer: Cofinity Commercial |
$633.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$462.15
|
| Rate for Payer: Meridian Medicaid |
$314.45
|
| Rate for Payer: Nomi Health Commercial |
$528.17
|
| Rate for Payer: PACE SWMI |
$440.14
|
| Rate for Payer: PHP Commercial |
$616.20
|
| Rate for Payer: PHP Medicare Advantage |
$440.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$299.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.44
|
| Rate for Payer: Priority Health Medicare |
$440.14
|
| Rate for Payer: Priority Health Narrow Network |
$641.44
|
| Rate for Payer: Priority Health SBD |
$641.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$440.14
|
| Rate for Payer: UHC Medicare Advantage |
$440.14
|
| Rate for Payer: UHCCP Medicaid |
$299.48
|
| Rate for Payer: UMR Bronson Commercial |
$682.18
|
|
|
PR REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 27658
|
| Min. Negotiated Rate |
$212.38 |
| Max. Negotiated Rate |
$845.65 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Aetna Medicare |
$370.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.03
|
| Rate for Payer: BCBS Complete |
$254.51
|
| Rate for Payer: BCBS MAPPO |
$356.27
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: BCN Commercial |
$542.92
|
| Rate for Payer: BCN Medicare Advantage |
$356.27
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$477.40
|
| Rate for Payer: Cofinity Commercial |
$513.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$356.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.08
|
| Rate for Payer: Meridian Medicaid |
$254.51
|
| Rate for Payer: Nomi Health Commercial |
$427.52
|
| Rate for Payer: PACE SWMI |
$356.27
|
| Rate for Payer: PHP Commercial |
$498.78
|
| Rate for Payer: PHP Medicare Advantage |
$356.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$571.96
|
| Rate for Payer: Priority Health Medicare |
$356.27
|
| Rate for Payer: Priority Health Narrow Network |
$571.96
|
| Rate for Payer: Priority Health SBD |
$571.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$356.27
|
| Rate for Payer: UHC Medicare Advantage |
$356.27
|
| Rate for Payer: UHCCP Medicaid |
$242.39
|
| Rate for Payer: UMR Bronson Commercial |
$598.46
|
|
|
PR REPAIR INCOMPLETE CIRCUMCISION
|
Professional
|
Both
|
$409.00
|
|
|
Service Code
|
HCPCS 54163
|
| Min. Negotiated Rate |
$141.86 |
| Max. Negotiated Rate |
$452.22 |
| Rate for Payer: Aetna Commercial |
$280.33
|
| Rate for Payer: Aetna Medicare |
$217.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.25
|
| Rate for Payer: BCBS Complete |
$148.95
|
| Rate for Payer: BCBS MAPPO |
$209.20
|
| Rate for Payer: BCBS Trust/PPO |
$452.22
|
| Rate for Payer: BCN Commercial |
$317.15
|
| Rate for Payer: BCN Medicare Advantage |
$209.20
|
| Rate for Payer: Cash Price |
$327.20
|
| Rate for Payer: Cash Price |
$327.20
|
| Rate for Payer: Cofinity Commercial |
$280.33
|
| Rate for Payer: Cofinity Commercial |
$301.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.66
|
| Rate for Payer: Meridian Medicaid |
$148.95
|
| Rate for Payer: Nomi Health Commercial |
$251.04
|
| Rate for Payer: PACE SWMI |
$209.20
|
| Rate for Payer: PHP Commercial |
$292.88
|
| Rate for Payer: PHP Medicare Advantage |
$209.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$352.05
|
| Rate for Payer: Priority Health Medicare |
$209.20
|
| Rate for Payer: Priority Health Narrow Network |
$352.05
|
| Rate for Payer: Priority Health SBD |
$352.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.20
|
| Rate for Payer: UHC Medicare Advantage |
$209.20
|
| Rate for Payer: UHCCP Medicaid |
$141.86
|
| Rate for Payer: UMR Bronson Commercial |
$188.14
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM
|
Professional
|
Both
|
$1,017.00
|
|
|
Service Code
|
HCPCS 12055
|
| Min. Negotiated Rate |
$193.62 |
| Max. Negotiated Rate |
$747.19 |
| Rate for Payer: Aetna Commercial |
$385.61
|
| Rate for Payer: Aetna Medicare |
$299.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.39
|
| Rate for Payer: BCBS Complete |
$203.30
|
| Rate for Payer: BCBS MAPPO |
$287.77
|
| Rate for Payer: BCBS Trust/PPO |
$364.91
|
| Rate for Payer: BCN Commercial |
$747.19
|
| Rate for Payer: BCN Medicare Advantage |
$287.77
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cofinity Commercial |
$385.61
|
| Rate for Payer: Cofinity Commercial |
$414.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.16
|
| Rate for Payer: Meridian Medicaid |
$203.30
|
| Rate for Payer: Nomi Health Commercial |
$345.32
|
| Rate for Payer: PACE SWMI |
$287.77
|
| Rate for Payer: PHP Commercial |
$402.88
|
| Rate for Payer: PHP Medicare Advantage |
$287.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$408.62
|
| Rate for Payer: Priority Health Medicare |
$287.77
|
| Rate for Payer: Priority Health Narrow Network |
$408.62
|
| Rate for Payer: Priority Health SBD |
$408.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.77
|
| Rate for Payer: UHC Medicare Advantage |
$287.77
|
| Rate for Payer: UHCCP Medicaid |
$193.62
|
| Rate for Payer: UMR Bronson Commercial |
$467.82
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$160.99 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna American Axle |
$289.25
|
| Rate for Payer: Aetna Commercial |
$378.25
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$246.95
|
| Rate for Payer: BCN Commercial |
$246.95
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$311.50
|
| Rate for Payer: Cofinity Commercial |
$382.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$311.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$400.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.75
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.25
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$378.25
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$280.35
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.09
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$160.99
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: UMR Bronson Commercial |
$164.65
|
| Rate for Payer: VA VA |
$391.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.75
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Aetna American Axle |
$289.25
|
| Rate for Payer: Aetna Commercial |
$378.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.25
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$311.50
|
| Rate for Payer: Cofinity Commercial |
$382.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$311.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.00
|
| Rate for Payer: Healthscope Commercial |
$400.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.25
|
| Rate for Payer: PHP Commercial |
$378.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health SBD |
$280.35
|
| Rate for Payer: UMR Bronson Commercial |
$195.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.75
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 12051
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$417.33 |
| Rate for Payer: Aetna Commercial |
$213.66
|
| Rate for Payer: Aetna Medicare |
$165.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.61
|
| Rate for Payer: BCBS Complete |
$114.06
|
| Rate for Payer: BCBS MAPPO |
$159.45
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$417.33
|
| Rate for Payer: BCN Medicare Advantage |
$159.45
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$213.66
|
| Rate for Payer: Cofinity Commercial |
$229.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.42
|
| Rate for Payer: Meridian Medicaid |
$114.06
|
| Rate for Payer: Nomi Health Commercial |
$191.34
|
| Rate for Payer: PACE SWMI |
$159.45
|
| Rate for Payer: PHP Commercial |
$223.23
|
| Rate for Payer: PHP Medicare Advantage |
$159.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.37
|
| Rate for Payer: Priority Health Medicare |
$159.45
|
| Rate for Payer: Priority Health Narrow Network |
$229.37
|
| Rate for Payer: Priority Health SBD |
$229.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.45
|
| Rate for Payer: UHC Medicare Advantage |
$159.45
|
| Rate for Payer: UHCCP Medicaid |
$108.63
|
| Rate for Payer: UMR Bronson Commercial |
$204.70
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
12051
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$417.33 |
| Rate for Payer: Aetna Commercial |
$213.66
|
| Rate for Payer: Aetna Medicare |
$165.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.61
|
| Rate for Payer: BCBS Complete |
$114.06
|
| Rate for Payer: BCBS MAPPO |
$159.45
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$417.33
|
| Rate for Payer: BCN Medicare Advantage |
$159.45
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$229.61
|
| Rate for Payer: Cofinity Commercial |
$213.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.42
|
| Rate for Payer: Meridian Medicaid |
$114.06
|
| Rate for Payer: Nomi Health Commercial |
$191.34
|
| Rate for Payer: PACE SWMI |
$159.45
|
| Rate for Payer: PHP Commercial |
$223.23
|
| Rate for Payer: PHP Medicare Advantage |
$159.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.37
|
| Rate for Payer: Priority Health Medicare |
$159.45
|
| Rate for Payer: Priority Health Narrow Network |
$229.37
|
| Rate for Payer: Priority Health SBD |
$229.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.45
|
| Rate for Payer: UHC Medicare Advantage |
$159.45
|
| Rate for Payer: UHCCP Medicaid |
$108.63
|
| Rate for Payer: UMR Bronson Commercial |
$204.70
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna American Axle |
$364.00
|
| Rate for Payer: Aetna Commercial |
$476.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$481.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.00
|
| Rate for Payer: Healthscope Commercial |
$504.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$392.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$420.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: PHP Commercial |
$476.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health SBD |
$352.80
|
| Rate for Payer: UMR Bronson Commercial |
$246.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$420.00
|
|
